cholecystectomy
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Introduction
Surgical removal of the gall bladder.
Indications
- gallbladder disease
- cholecystitis
- symptomatic cholelithiasis, biliary colic[7]
- gallstones > 3 cm to prevent gallbladder cancer[4]
- gallbladder polyps > 1 cm[4]
- not indicated for asymptomatic cholelithiasis
* laparoscopic cholecystectomy can be safely performed during pregnancy, epecially in the 2nd trimester[4]
* using strict criteria for cholecystectomy did not improve pain after 1 year[6]
- severe pain attacks
- pain lasting at least 15 minutes
- pain located in epigastrium or right upper quadrant
- pain radiating to the back
- positive pain response to simple analgesics
* predictors of benefit for symptomatic cholelithiasis include older age, no history of abdominal surgery, pain radiating to back, nausea, no heartburn[7]
Procedure
- open cholecystectomy
- laparoscopic cholecystectomy
- cholangiography to identify common bile duct stones
Complications
- injury to the common bile duct
- choledocholelithiasis
- 20% of patients with recurrent choledocholelithiasis[4]
- episodic biliary pain, dilated common bile duct
- no signs of peritonitis[4]
- ducts of Luschka may be incompletely cauterized or remain unobserved, leading to biliary leak post operatively; biliary peritonitis within 5 to 7 days following surgery, & will require a temporary biliary stent (more common with laparoscopic cholecystectomy)
- *** according to ref[4], a bile leak would occur within 1-2 days of surgery, pain would be constant, & signs of peritonitis would be present***
- persistent pain after 4 years in 1/3 of patients[8]
Management
- follow-up cholangiography may be needed in patients with recurrent choledocholelithiasis[5]
More general terms
References
- ↑ Wikipedia: Cholecystectomy http://en.wikipedia.org/wiki/Cholecystectomy
- ↑ Baron TH, Grimm IS, Swanstrom LL. Interventional Approaches to Gallbladder Disease. N Engl J Med 2015; 373:357-365. July 23, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26200981 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1411372
- ↑ Thistle JL, Longstreth GF, Romero Y et al Factors that predict relief from upper abdominal pain after cholecystectomy. Clin Gastroenterol Hepatol. 2011 Oct;9(10):891-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21699805
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Medical Knowledge Self Assessment Program (MKSAP) 17, 19. American College of Physicians, Philadelphia 2015, 2021
- ↑ 5.0 5.1 Yoo ES, Yoo BM, Kim JH et al. Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy. Scand J Gastroenterol 2018 Feb 19 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29457922 https://www.tandfonline.com/doi/abs/10.1080/00365521.2018.1438507?journalCode=igas20
- ↑ 6.0 6.1 van Dijk AH, Wennmacker SZ, de Reuver PR et al Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial Lancet. April 26, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31036336 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30941-9/fulltext
Guest RV, Soreide K Pain after cholecystectomy for symptomatic gallstones. Lancet. April 26, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31036335 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30959-6/fulltext - ↑ 7.0 7.1 7.2 Latenstein CSS, Hannink G, van der Bilt JDW et al. A clinical decision tool for selection of patients with symptomatic cholelithiasis for cholecystectomy based on reduction of pain and a pain-free state following surgery. JAMA Surg 2021 Aug 11; 156:e213706. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34379080 PMCID: PMC8358816 (available on 2022-08-11) https://jamanetwork.com/journals/jamasurgery/article-abstract/2782931
- ↑ 8.0 8.1 Comes DJ, Wennmacker SZ, Latenstein CSS et al Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones: 5-Year Follow-Up of the SECURE Randomized Clinical Trial. JAMA Surg. 2024 Aug 21:e243080. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39167382 PMCID: PMC11339699 Free PMC article.
- ↑ Gallstones and Laparoscopic Cholecystectomy http://consensus.nih.gov/cons/090/090_intro.htm